Shoulder Impingement Syndrome

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Shoulder Impingement Syndrome

The gleno-humeral joint is commonly accepted to be the most complex joint in the human body. Possibly due to the difficulty of arriving at an accurate diagnosis, the term "shoulder impingement syndrome" (SIS) has become a standard term in shoulder diagnosis. Any condition that narrows the space between the anterior/inferior aspect of the acromion and coracoacromial ligament can result in SIS (1). The most common causative factors are a thickened subacromial bursa and rotator cuff tendonopathy.

Jablonski's Dictionary of Syndromes and Eponymic Diseases (2nd edition) defines shoulder impingement syndrome as "Compression of the rotator cuff tendons and subacromial bursa between the humeral head and structures that make up the coracoacromial arch and the humeral tuberosities. This condition is associated with subacromial bursitis and rotator cuff (largely supraspinatus) and bicipital tendon inflammation, with or without degenerative changes in the tendon. Pain that is most severe when the arm is abducted in an arc between 40 and 120 degrees, sometimes associated with tears in the rotator cuff, is the chief symptom."

Clinical Reviews

Very few high quality studies have been performed to determine risk factors for developing shoulder impingement syndrome (SIS). Much of what we know relating to risk actors is based on clinical common sense and lower level clinical studies.

The gleno-humeral joint is commonly accepted to be the most complex joint in the human body. Possibly due to the difficulty of arriving at an accurate diagnosis, the term "shoulder impingement syndrome" (SIS) has become a standard term in shoulder diagnosis. Any condition that narrows the space between the anterior/inferior aspect of the acromion and coracoacromial ligament can result in SIS. The most common causative factors are a thickened subacromial bursa and rotator cuff tendonopathy.

Effectively treating shoulder pain is a challenge to every clinician. Only limited evidence exists in determining effectiveness for most interventions. A significant problem encountered is the wide varieties of pathologies which may cause shoulder pain and the lack of consistent diagnostic criteria for these different pathologies. For the purpose of this monograph only studies relating to shoulder impingement syndrome will be discussed.

Medical Subject Heading (MeSH) Information

MeSH Term: Shoulder Impingement Syndrome

Scope Note: Compression of the ROTATOR CUFF tendons and subacromial bursa between the HUMERAL HEAD and the ACROMION of the SCAPULA. This condition is associated with subacromial BURSITIS, as well as rotator cuff (largely supraspinatus) and bicipital tendon INFLAMMATION.

Informative Links

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Current Clinical Trials Relating to
Shoulder Impingement Syndrome

ClinicalTrials.gov: Provides patients, family members, and members of the public easy and free access to information on clinical studies for a wide range of diseases and conditions.

(Status: Terminated)

(Status: Completed)

Harrison Ndetan, MSc, MPH, DrPH

The chiropractic profession relies largely upon specialized manual therapy procedures (adjustment/manipulation) as a means of patient care. The methods of delivering chiropractic adjustments are not homogeneous and often require complex motor skills. These manipulative procedures involve biomechanical variables such as velocity, amplitude and the line of drive of force. Consideration of these variables is important in order to render them therapeutically safe and functionally effective. Learning these techniques in private practice or in chiropractic colleges is a process that involves significant repetition. These teaching methods have potentially damaging effects. Doctors or students learning new manipulative procedures are initially at greater risk in the skill acquisition phase, when the neuromuscular system is adapting to the new skills associated with the manipulative procedure. Epidemiological studies demonstrate that work related musculoskeletal disorders are common among health providers. Chiropractors also risk injuries of various types related to their work. Some DC's are forced to leave practice due to injury sustained in practice. Thus, an emphasis needs to be placed upon safety to ensure practice longevity.

Parker College of Chiropractic Research Institute |

February 5, 2008

Daniel A. Martinez, MA, DC, Research Scientist

Cold application (cryotherapy) is the simplest and most commonly used method for treatment of acute musculoskeletal injury. Among chiropractic practitioners it is the most often utilized (94.5%) passive adjunctive therapy. The pathophysiological effects of cold have been well documented. Studies have shown that cold applications can reduce the metabolic rate of a tissue, decrease pain and swelling, and reduce muscle spasm. Most health care practitioners are taught to use ice therapy for treatment of bruises, strains, sprains, or muscle tears and most are familiar with the rest, ice, compression, and elevation (RICE) principle following acute soft tissue injury, yet there is little agreement in the literature on the optimum application technique for such care.

Parker College of Chiropractic Research Institute |

February 4, 2008

Harrison Ndetan, MSc, MPH, DrPH

Harrison Ndetan is a graduate from the University of Buea - Cameroon, West Africa; with B.Sc. and M. Sc. degrees in physics and computer science. He was introduced to applied statistics by the London-based ACCA program and had primary exposures to the imaging modalities for diagnostic medicine in the college of medical physics at the International Center for Theoretical Physics (ICTP), Trieste – Italy. He obtained an MPH degree from and is currently a doctoral candidate in Biostatistics at the School of Public Health, University of North Texas, Health Science Center (UNTHSC), Fort Worth, Texas.

Daniel A. Martinez, MA, DC, Research Scientist

Dr. Daniel (Dan) Martinez finally decided to join the family business and graduated from Parker College of Chiropractic in January 2007. He is the fourth brother in a family of eight to become chiropractors. An individual with many interests, he studied art and music at the University of Central Oklahoma and received his Bachelor of Art in 1980. After graduation he moved to Dallas, to pursue a career in commercial art. He studied massage therapy as a means of learning anatomy to improve his art skills. This study led him to pursue the study of anatomy in much greater detail. He was accepted into the Master's of Medical Illustration program at the University of Texas Southwestern Medical Center at Dallas in 1994 and received his Master's in Biomedical Communications in 1997. Before entering his Master’s program, he worked as an osteological photographer for the Freedman’s cemetery archaeological project with the University of Texas Southwestern Medical Center at Dallas. While working on his thesis, he worked as a laboratory technician for the obstetric and gynecology department, also with the University of Texas Southwestern Medical Center at Dallas. He began teaching anatomy and physiology for the Dallas County Community College District (DCCCD) in 1996 and has been teaching as an adjunct professor until 2008.

Dr. Martinez emphasis is in clinical research and has been published in the peer-reviewed press. He also is primary lecturer for the Parker College of Chiropractic Research Method class. Dr. Martinez is fluent in Spanish. His goals include helping to establish research protocols for Parker’s Latin American sister schools and clinics.

(Shoulder Impingement Syndrome: Therapy)

A 2005 Cochrane Review of 9 clinical trials concluded there was insufficient evidence to state acupuncture is effective in the treatment of shoulder pain (6). However, a randomized controlled trial....

January 28, 2008

(Shoulder Impingement Syndrome: Prevention)

Fongemie et al reference cadaveric studies that show the shape of the acromion may play a role in the etiology of SIS, particularly rotator cuff (RC) tears (12). These studies show a downward curving....

Published On

January 28, 2008

(Shoulder Impingement Syndrome: Prevention)

Overhead athletic activities such as throwing a baseball and swimming have long been implicated in the etiology of SIS. The biomechanics causing injury have been discussed in the literature although....

February 15, 2008

(Shoulder Impingement Syndrome: Diagnosis)

"The patient is asked to abduct his shoulder to 90° and then to let the arm down slowly. If the patient cannot do this and the arm drops immediately with pain, the test is then positive" for rotator....

Published On

February 15, 2008

(Shoulder Impingement Syndrome: Therapy)

Although electrotherapy is often used in the treatment of SIS there is very limited evidence for its effectiveness. One review fails to even discuss electrotherapy as a treatment alternative for SIS....

Published On

January 7, 2008

(Shoulder Impingement Syndrome: Therapy)

A 2003 Cochrane Review found exercise to be effective in both the short and long term for shoulder impingement syndrome (SIS) (1). A separate review, published in 2004 concluded therapeutic exercises....

February 15, 2008

(Shoulder Impingement Syndrome: Diagnosis)

"The dorsal aspect of the hand is placed on the ipsilateral buttock and the hand is then lifted off the buttocks 1-2". The hand is lifted further against the resistance applied by the examiner" (4).....

Published On

February 15, 2008

(Shoulder Impingement Syndrome: Therapy)

The 2003 Cochrane Review (mentioned above) concluded that there is insufficient evidence for the use of low level laser in the treatment of rotator cuff pathology (1). A RCT of 35 patients compared a....

February 15, 2008

(Shoulder Impingement Syndrome: Therapy)

Several randomized controlled trials (RCT) address the efficacy of manipulation or mobilization in the treatment of shoulder pain. In a RCT of 150 patients with mixed diagnosis resulting in shoulder....

February 15, 2008

(Shoulder Impingement Syndrome: Therapy)

Two reviews and 1 meta-analysis have been published relating to steroid injections. The meta-analysis of 7 studies concluded injections were effective up to 9 months in the treatment of rotator cuff....

February 15, 2008

(Shoulder Impingement Syndrome: Therapy)

A 2008 Cochrane Report, which included 14 RCTs, concluded "we cannot draw firm conclusions about the effectiveness or safety of surgery for rotator cuff disease." Additionally they state "there is no....

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